BMA Concise Guide to Medicine & Drugs

Colchicine

Brand name None

Used in the following combined preparations None

QUICK REFERENCE

Drug group Drug for gout

Overdose danger rating High

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Colchicine, a drug originally extracted from the autumn crocus flower and later synthesized, has been used since the 18th century for gout. It has now, to an extent, been superseded by newer drugs, but is still often used to relieve joint pain and inflammation in flare-ups of gout. Colchicine is most effective when taken at the first sign of symptoms, and almost always produces an improvement. Its use is limited by the development of side effects, such as nausea, vomiting and diarrhoea, at high doses. The drug may also be given at a lower dose during the first few months of treatment with allopurinol or probenecid (other drugs for gout), because these may at first increase the frequency of gout attacks.

Colchicine is occasionally prescribed for the relief of symptoms of familial Mediterranean fever (a rare congenital condition).

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets.

Frequency and timing of doses Prevention of gout attacks Twice daily. Relief of gout attacks Every 4 hours.

Adult dosage range Prevention of gout attacks 1–1.5mg daily. Relief of gout attacks 1mg initially, followed by 0.5mg every 4 hours, until relief of pain, vomiting, or diarrhoea occurs, or until a total dose of 6mg is reached. This course must not be repeated within 3 days.

Onset of effect Relief of symptoms in an attack of gout may be felt in 6–24 hours. Full effect in gout prevention may not be felt for several days.

Duration of action Up to 2 hours. Some effect may last longer.

Diet advice Certain foods are known to make gout worse. Discuss with your doctor.

Storage Keep in original container at room temperature out of the reach of children. Protect from light.

Missed dose Take as soon as you remember. If your next dose is due within 30 minutes, take a single dose now and skip the next.

Stopping the drug When taking colchicine frequently during an acute attack of gout, stop if diarrhoea or abdominal pain develop. In other cases, do not stop without consulting your doctor.

OVERDOSE ACTION

Seek immediate medical advice in all cases; some reactions can be fatal. Take emergency action if severe nausea, vomiting, bloody diarrhoea, severe abdominal pain, or loss of consciousness occur.

POSSIBLE ADVERSE EFFECTS

The appearance of any symptom that may be an adverse effect of colchicine is a sign that you should stop taking it until you have received medical advice. The more common adverse effects are nausea, vomiting, diarrhoea, and abdominal pain. More rarely, colchicine may cause numbness and tingling, unusual bleeding or bruising, and a rash.

INTERACTIONS

Ciclosporin Taking ciclosporin with colchicine may lead to adverse effects on the kidneys and muscles.

Erythromycin and clarithromycin may increase the adverse effects of colchicine.

Statins Taking statins with colchicine may increase the risk of adverse effects on the muscles.

Protease inhibitors may increase the risk of colchicine toxicity.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have long-term liver or kidney problems.

· You have heart problems.

· You have a blood disorder.

· You have stomach ulcers.

· You have chronic inflammation of the bowel.

· You are taking other medicines.

Pregnancy Not recommended. May cause defects in the unborn baby. Discuss with your doctor.

Breast-feeding The drug passes into the breast milk and may affect the baby. Discuss with your doctor.

Infants and children Not recommended.

Over 60 Increased likelihood of adverse effects.

Driving and hazardous work No special problems.

Alcohol Avoid. Alcohol may increase stomach irritation caused by colchicine.

PROLONGED USE

Prolonged use of this drug may lead to hair loss, rashes, tingling in the hands and feet, muscle pain and weakness, and blood disorders.

Monitoring Periodic blood checks are usually required.